<!DOCTYPE html>
<html>

	<head>
		<meta name="viewport" content="width=device-width, initial-scale=1, maximum-scale=1, user-scalable=no" charset="utf-8">
		<title>地址</title>
		<link rel="stylesheet" href="css/bootstrap.min.css" />
		<script type="text/javascript" src="js/bootstrap.min.js"></script>
	</head>

	<body style="background: #F5F5F5;overflow:hidden;">
		<div class="" style="height: 35px; line-height: 35px;  border-bottom: 1px solid #CCCCCC;">
			<p>收货地址 </p>
		</div>
		<form action="" method="post" >
			<div class="container" style="height: 35px; background: white;">
				<div class="col-xs-3" style="padding: 0px; line-height: 35px;border-bottom: 1px solid #CCCCCC;">
					收货人
				</div>
				<div class="col-xs-9" style="padding: 0px; ">
					<input type="text" class="" placeholder="必填" name="" id="" value="" style=" border: white; border-bottom: 1px solid #CCCCCC;height: 36px; width: 100%;" />
				</div>
			</div>
			<div class="container" style="height: 35px; background: white; ">
				<div class="col-xs-3" style="padding: 0px; line-height: 35px;border-bottom: 1px solid #CCCCCC;">
					手机号
				</div>
				<div class="col-xs-9" style="padding: 0px;">
					<input type="text" class="" placeholder="必填" name="" id="" value="" style=" border: white; border-bottom: 1px solid #CCCCCC;height: 36px; width: 100%;" />
				</div>
			</div>
			<div class="container" style="height: 38px; background: white;">
				<div class="col-xs-3" style="padding: 0px; line-height: 35px;">
					微信号
				</div>
				<div class="col-xs-9" style="padding: 0px;">
					<input type="text" class="" placeholder="" name="" id="" value="" style=" border: white; height: 36px; width: 100%;" />
				</div>
			</div>
			<div class="container" style="height: 38px; margin-top: 10px; background: white;">
				<div class="col-xs-3" style=" font-size: 13px; padding: 0px; line-height: 35px;border-bottom: 1px solid #CCCCCC;">
					收货地址
				</div>
				<div class="col-xs-9" style="padding: 0px;border-bottom: 1px solid #CCCCCC;margin-top: 1px;">
					<div class="col-xs-6" style="padding: 0px;">
					<select class="form-control"  >
						 <option>请选择城市</option>  
							<option>1</option>
							<option>2</option>
							<option>3</option>
							<option>4</option>
							<option>5</option>
						</select>
					</div>
					<div class="col-xs-6 " style="padding: 0px;">
						<select class="form-control" >
							<option>请选择城市</option>  
							<option>2</option>
							<option>3</option>
							<option>4</option>
							<option>5</option>
						</select>
					</div>
				</div>
			</div>
			<div class="container " style="height: 38px; background: white; ">
				<div class="col-xs-3 " style="padding: 0px; line-height: 35px; ">
					详细地址
				</div>
				<div class="col-xs-9 " style="padding: 0px; ">
					<textarea class="form-control " rows="1 " style="border: white; "></textarea>
				</div>
			</div>
			
			<div class="container" style="text-align: center;">				
				 <input type="submit" id="" class="btn btn-danger" name="" style="text-align: center; width: 300px;" value="确认"/>
			</div>
		</form>
	</body>

</html>